Study For The Treatment And Follow-up Of Periprosthetic Femoral Fractures Associated With Hiparthroplasty

Objective:Total hip arthroplasty (THA) is currently the most effective and proven treatment for severe hip disease. Periprosthetic femur fracture (PFFs) after surgery is one of most severe complications of THA, whose incidence is increasing, and is difficult to treat. The main reason of periprosthetic fracture are trauma, renovations treatment, the patient aging, type of prosthesis, prosthesis fixation and increase of joint activity, etc, and also the occurrence of fractures. Vancouver typing method is mainly used in the classification of periprosthetic fracture, which includes factors such as fracture sites, the type of bone fractures, prosthesis fixation, the loosening of the prosthesis and the loss of the proximal femur bone, ect,, and has good guidance value for the clinical treatment of peripheral femoral fractures. The treatments of the periprosthetic fractures include shape memory alloy embracing, invasive stabilization system, locking compression plate, allograft cortical bone plates, carbon fiber, bone grafting and other fixed and renovation. Improving treatment of periprosthetic fractures and technology has become one of the topics studied. This article aims to clear a variety of methods for treatment of periprosthetic fractures and make a 3-36 months postoperative follow-up(12 months on average),in order to obtain the improvements in surgery technology and the quality of lives of patients and supply the theoretical reference information.Method:Collected 16 cases of periprosthetic fractures after THA or HR from the Bone Surgery, Qilu Hospital of Shandong University, in March 2010 to March 2016. Time of occurrence for the periprosthetic fracture is from 20 days to 230 months after the primary THA or HA. According to the Vancouver fracture typing system, they are classified into:2 cases of type A,2 cases of type B1,8 cases of type B2,3 cases of type B3,1 case of type C. Open reduction and internal fixation in 5 cases, simply replace the prosthesis in 7 cases, revision total hip arthroplasty in 4 cases; Fixing method are as follows:open reduction, pure titanium cable tying or binding of the greater trochanter plate fixation in 2 cases; Open reduction, titanium cable/wire rope tying combination locking plate and screw fixation in 2 cases; Open reduction, a simple locking plate and screw fixation in 1 case; Row Groups allotment bone prosthesis or long-handled femoral prosthesis combining titanium wire or wires bunched fixed in 8 cases, combined with locking plate or locking screw, if necessary, fixed monocortical; Row Groups allotment bone prosthesis or long-handled femoral prosthesis combining allogeneic bone plate and steel wire or titanium wire bundling fixed 3 cases, combined fixator is fixed, if necessary.Patients were followed up regularly in the hospital review by reviewing imaging data and made comprehensive assessments with Harris score.Result:The present study was carried out after the regular follow-up of 15. patients,1 patient could not be contacted and lost, up from 3 to 36 months (mean 24 months), X-ray sheets show healing signs in 3 months after surgery, the mean healing time was 4 months, observed bone connection exists between some patients implanted cortical bone allograft and host bone plate. After 12 months of follow-up, we found that patients fully consistent fracture, femoral anatomical axis normal, good bone healing, bone and autogenous bone graft for the integrated,3-5mm measurable increase in cortical thickness, average thickening of 4.42mm, no significant complications occur. After 12 months, when the hip joint function and good activity, daily activities pain and dysfunction occurs. Harris scores 75.5 to 94.2 points, an average of 85.4 points, excellent rate of 81%, and the last follow-up Harris score was 88.2 points. Preoperative lower limb compared with the contralateral lower limb shortening average of 2.35cm, postoperative lower limb compared with the contralateral lower limb shortening average of 0.17cm, the difference was statistically significant (P <0.01). One case of B3 type of fracture group, postoperative 20 days due to a fall caused by dislocation of the femoral head again open reduction and internal fixation, and good recovery finally appear. None of the patients happened with neurological disorders or significant intraoperative nerve or vascular injury after lower extremity sensory, motor, etc.Conclusion:Total hip hemiarthroplasty or different for postoperative periprosthetic femoral fracture, fracture type and location vary, select the appropriate type of fracture is essential for guiding clinical treatment. Vancouver typing is joint or partial hip arthroplasty femoral periprosthetic hip fractures relatively simple and practical method of classification, conducting appropriate type according to the individual circumstances of different patients and then select individualized treatment plan is significant for the quality of life for patients and hip function recovery effect. Vancouver B type is more common in hip femoral periprosthetic fracture cases,.Open reduction and plate fixation, or long-handled prosthesis revision combined with bone allograft bone plate, steel wire or titanium wire binding tying fixation can achieve good therapeutic effect. Patients of type A should choose titanium cable bundled cable or fixed prosthesis revision and other treatment methods according to how many lost of bone mass. For vancouver C patients with fractures, it should select the corresponding treatment approaches based on the specific circumstances of fracture. Under normal circumstances we can make the combination of open reduction and locking plate and screw fixation fracture fixation system, if bone loss is severe we can make some graft. Clinically active treatment should be given depending on the type of fracture. For more severe cases of fracture (such as B2, B3 type) it is recommended to use a sufficient length of prosthesis. Periprosthetic fracture after THA should be diagnosed through clinical symptoms and imaging (X-ray), make rational assess of fractures by classification systems. Surgeons must master the principles of treatment of PFFs and select or develop the best treatment plan to achieve the desired therapeutic purposes for different patients according to their fracture characteristics.